MA/FS Second Party Review Overview - PowerPoint PPT Presentation

MA/FS Second Party Review Overview. March, 2006. This presentation is intended to be used as an optional supplement to the information communicated through the Operations Memo 06-05 and the Administrator’s Memo 06-02 on this topic. Second Party Review Process Changes .

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While some IM agencies have been conducting informal MA second party reviews, the Management Evaluation Reviews (MER) found that MA case reviews were not being completed by a majority of the agencies surveyed.

Input from the Income Maintenance Advisory Committee (IMAC), the Medicaid Eligibility Quality Control (MEQC) project and the Legislative Audit Bureau (LAB) resulted in the decision to implement a uniform method for IM agencies across the state to complete MA second party reviews.

The 2006 state and county contract that includes IM contains language requiring second party reviews of Medicaid cases.

Cases identified for review can be selected from a list generated from CARES. The case review sample will be produced on the first Saturday of the month and will be available the following Monday.

In the future, local agencies may also enter cases manually that are considered problem cases (e.g. fair hearing, client complaints, etc.). These are cases that someone may already be looking at for other reasons, and can count toward the required review percentage.

The FS sample case selection criteria will be the same as the 2005 second party reviews (applications and reviews with household size greater than 2 and issuance greater than $100).

It is recommended that any agency staff who will be conducting second party reviews become familiar with the IMQA Second Party Review Manual priorto conducting any second party reviews using the new process and IMQA tool.

The IMQA Second Party Review Manual can also serve as an ongoing resource available any time anyone wants to know more about the second party review process or the IMQA tool.